Canadians Do Not Look To Doctors For Obesity Management

This week, Sara Kirk (Dalhousie University, Halifax) and colleagues publish the results of a national survey on weight management experiences of overweight and obese Canadian adults, in Chronic Diseases and Injuries in Canada.

The survey was conducted by Ipsos Reid on behalf of the Canadian Obesity Network, and in March/April 2009, and included 23 questions related to weight management practices and other variables.

While over half the survey respondents reported being overweight or obese, surprisingly few had asked for or received weight loss advice from a health care professional. This was despite the fact that the majority of survey respondents reported visiting their physician in the previous 12 months, significantly more so if they were obese.

Although almost three-quarters of the overweight and obese Canadian adults surveyed had tried to lose weight (58% in the previous 12 months), only 21% reported seeking help from their physician in the previous year.

On the other hand, less than one-third of overweight/obese individuals had ever been advised to lose weight by a physician (without specifically asking). In 19% of overweight or obese respondents, this advice was understood to have been given to improve health in general, and in 12%, to improve the treatment of some other medical condition. This pattern was similar for men and for women.

Advice to lose weight was more often given to middle-aged (35–54 years; 21%) and older adults (≥ 55 years; 24%) than younger adults (18–34 years; 11%), and increased with increasing BMI.

As one may expect, most of the advise focussed on diet and exercise (Eat-Less-Move-More?). Medical and surgical treatments were seldom discussed.

This study certainly shows that Canadians are not looking to their physicians (or for that matter to any health professionals) for advise on their weight management, and physicians, in turn, do not seem to be eagerly offering this advise to their patients.

The good news is that there is apparently a lot of room to move on this issue – an effort that the Canadian Obesity Network is certainly working very hard to champion.

AMS
Edmonton, Alberta

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10 Comments

Seriously, why would people go to doctors for Obesity management? Doctor’s really aren’t trained in nutrition, and a lot of them still push the low fat nonsense that helped start the obesity tidal wave rolling. They don’t really know much about exercise or setting up exercise programs. There aren’t many approved Drug options available that don’t have worse side effects, and the path to new drug approval for obesity treatments is problematic. Currently the best medical answer is surgery.

Unless you are ready to throw in the towel on eat less move more, a strategy that actually does work for those who are able to execute it, and go under the knife, Obesity simply isn’t a problem that the medical community has a wealth of tools to deal with. Until better safer drugs are available, I wouldn’t really recommend Obese folks go to doctors until they have convinced themselves that they can’t make Eat Less Move More work for them. At that point, they may as well go under the knife, because cost/benefit probably does go in the direction of surgery.

One of the reasons for the outcome of this study is that most family physicians are, bluntly, quite lousy in providing any kind of useful weight management advice and/or guidance – other than to keep telling you to “lose weight.”

Rather than doctors, perhaps patients should be directed to a primary health care team including a registered dietitian where they would be helped primarily around healthy eating goals vs. weight loss. Altering someone’s diet takes time, knowledge and skill on both the practitioner’s part and the patient’s. Doctors don’t have the time (or nutrition knowledge), and if they did it would cost a lot more. We need to start looking at how family health teams rather than family doctors can fix obesity. And that would mean changing the conversation about what professionals are needed in the “system”.

I think the very real truth is that most people who try to lose weight do so for aesthetic as opposed to health reasons (especially those with lower classes/stages of obesity). So it would make sense that they wouldn’t consider medical intervention for a goal that they don’t deem to be motivated by health.

Along the same lines, there is a big gap between telling someone that they should lose 5-10% of their weight versus the (unrealistic?) amount they actually WANT to lose.

And then there is the issue regarding the ability of medical professionals to actually address issues surrounding nutrition, exercise, and the psychosocial issues surrounding obesity. Lack of training and time restraints can limit the ability of many doctors to actually give adequate attention to these issues. Referring to specialized professionals (or even bariatric educators as Sean Wharton has done) in each area is, of course, an option but not something all doctors can or will do.

Many dietitians are still preaching the “breakfast is the most important meal” and “eat multiple meals to stoke the metabolism” mantras when research is starting to point towards the fact that meal frequency isn’t nearly as important as we’ve been led to believe for weight management which might be creating unnecessary meal preparation barriers for patients who might do just fine on one or two meals per day provided calories are controlled. More education is needed here and the public knows it.

Despite my above statements, I am all for more involvement of doctors in weight management and I think that the Canadian Obesity Network can definitely pave the way for this.

But at the same time, rather than chastising the army of commercial establishments and weight loss providers, perhaps the Obesity Network could work towards reaching out and educating these providers and creating an army of evidence based obesity fighters.

I’m 59 years old. When I was in my 30s & 40s the solution for EVERY medical issue seemed to be “lose weight.” When I asked for help I got the standard “eat less, exercise more” response with no further help. The only time I’ve been referred to a dietician was for GERD, & I only got one session with her. Now I am asked by my family doctor, and others, whether I have considered surgery. The other “useful” suggestion is that I join a gym, which is expensive & 60km away.
If people don’t ask their doctors about weight loss, it’s probably because the advice is not helpful, and family doctors don’t refer their patients to specialists who CAN help.

Is there any link to the Sarah Bleich article “Impact of Physian BMI on obesity care and beliefs” ?

Question : In primary care, isn’t it important to appoint one central coach, who guides an obese or overweight person during several years for this livelong condition ? A professional cannot change a lifestyl on three months… if he can at all.

A family doctor has a relation to his patient for several years. So why can’t he take this role as a coach, whithout being an expert on nutrition or exercise, but knowing these experts in his neighbourhoud and referring to them if necessary, according to the plan of coaching for several years ?

This means a change in role and task, because as a Western European GP, I’m teached to give advice on weight loss.

I assume all family physicians are given a guideline to follow regarding the treatment of all health conditions. Is this correct? I mean, if we have an ear infection they have to provide a standard of care. So what is the standard of care as it relates to obesity? Maybe obesity, in and of itself, is not considered a health matter until it causes another condition. Seems like a no win situation to me.

I say look to the Primary Care Nurse (of which I am one), particularly those trained in Chronic Disease Management. A vast majority of my clients want or need to lose weight, and mostly for the health benefits. We can provide the education, the referrals, the psycho-social support and most importantly we have the “time” it takes to help people with their complex health issues. Obesity management is not something that can be achieved in a 5-10 minute Dr’s appointment. There are simply too many factors surrounding each individuals causes for obesity. This means that clients need tailored and achievable goals for weight loss, which they set themselves, and continued support and motivation as they try to reach them.

In Belgium only 1 % of GP’s have the luxury of a Primary Care Nurse trained in Chronic Disease Management. The majority is working all alone. We still have to manage an increasing obesity care in Primary Care …. Maybe a change in attitude, education on “brief interventions” , cooperation with local private dieticians, referral to obesity clinics, …. can help.